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EP2659888A1 - Utilisation de l'acide aminolévulinique et de ses dérivés - Google Patents

Utilisation de l'acide aminolévulinique et de ses dérivés Download PDF

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Publication number
EP2659888A1
EP2659888A1 EP13173602.7A EP13173602A EP2659888A1 EP 2659888 A1 EP2659888 A1 EP 2659888A1 EP 13173602 A EP13173602 A EP 13173602A EP 2659888 A1 EP2659888 A1 EP 2659888A1
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Prior art keywords
pdt
composition
ala ester
ala
photosensitiser
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English (en)
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Photocure ASA
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Photocure ASA
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K41/00—Medicinal preparations obtained by treating materials with wave energy or particle radiation ; Therapies using these preparations
    • A61K41/0057—Photodynamic therapy with a photosensitizer, i.e. agent able to produce reactive oxygen species upon exposure to light or radiation, e.g. UV or visible light; photocleavage of nucleic acids with an agent
    • A61K41/0061—5-aminolevulinic acid-based PDT: 5-ALA-PDT involving porphyrins or precursors of protoporphyrins generated in vivo from 5-ALA
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
    • A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
    • A61K31/22—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin
    • A61K31/221—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin with compounds having an amino group, e.g. acetylcholine, acetylcarnitine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/06—Radiation therapy using light
    • A61N5/0613—Apparatus adapted for a specific treatment
    • A61N5/0616—Skin treatment other than tanning
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/06—Radiation therapy using light
    • A61N5/0613—Apparatus adapted for a specific treatment
    • A61N5/062—Photodynamic therapy, i.e. excitation of an agent
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A61P15/02—Drugs for genital or sexual disorders; Contraceptives for disorders of the vagina
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A61P17/02—Drugs for dermatological disorders for treating wounds, ulcers, burns, scars, keloids, or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A61P17/06—Antipsoriatics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A61P17/10—Anti-acne agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/04—Antibacterial agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/10—Antimycotics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/12—Antivirals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/12—Antivirals
    • A61P31/20—Antivirals for DNA viruses
    • A61P31/22—Antivirals for DNA viruses for herpes viruses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/06—Radiation therapy using light
    • A61N2005/065—Light sources therefor
    • A61N2005/0651—Diodes
    • A61N2005/0652—Arrays of diodes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/06—Radiation therapy using light
    • A61N2005/0658—Radiation therapy using light characterised by the wavelength of light used
    • A61N2005/0662—Visible light
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/06—Radiation therapy using light
    • A61N2005/0658—Radiation therapy using light characterised by the wavelength of light used
    • A61N2005/0662—Visible light
    • A61N2005/0663—Coloured light

Definitions

  • This invention relates to photodynamic therapy (PDT), and in particular to the use of 5-aminolevulinic acid (5-ALA) and derivatives of 5-ALA in PDT wherein the side-effects (e.g. pain and/or erythema) of PDT are prevented or reduced.
  • PDT photodynamic therapy
  • PDT photochemotherapy
  • PDT is a technique for the treatment of various abnormalities or disorders of the skin or other epithelial organs or mucosa, especially cancers or pre-cancerous lesions, as well as certain non-malignant lesions (e.g. skin complaints such as psoriasis, actinic keratoses (AK) and acne).
  • PDT involves the application of photosensitizing (photochemotherapeutic) agents to the affected area of the body, followed by exposure to photoactivating light in order to activate the photosensitizing agents and convert them into cytotoxic form, whereby the affected cells are killed or their proliferative potential diminished.
  • a range of photosensitizing agents are known, including the psoralens, the porphyrins (e.g. Photofrin®), the chlorins and the phthalocyanins.
  • photosensitizing agents include the psoralens, the porphyrins (e.g. Photofrin®), the chlorins and the phthalocyanins.
  • the most clinically useful photosensitizing agents known in the art are 5-aminolevulinic acid and its derivatives, for example esters such as 5-ALA esters.
  • WO2006/051269 discloses use of 5-ALA esters in PDT for the treatment of acne.
  • WO2006/051269 describes a study wherein a cream comprising 16 %wt methyl ALA ester is applied to the faces of subjects for 3 hours followed by exposure of the subjects' faces to non-coherent red light (light dose 37 Jcm -2 ). The treatment was then repeated 2 weeks later. Although the results confirmed that PDT with methyl ALA ester is effective in the treatment of acne, the subjects also indicated that the treatment caused some pain.
  • WO02/13788 discloses a similar study on use of ALA acid in PDT for the treatment of acne.
  • 20 % ALA acid was applied to the backs of the subjects for 3 hours and then the subjects were exposed to 150 J/cm 2 broad band light.
  • the results confirmed that PDT with ALA is effective for the treatment of acne, but the subjects also reported a plethora of undesirable side effects.
  • WO02/13788 reports that erythema, hyperpigmentation and exfoliation were often seen after PDT treatment and states that in some cases a subsequent treatment even had to be postponed. Reports of pain, burning and itching during and after treatment were also common.
  • WO02/13788 describes the above-described treatment regime as a "high dose, high energy” regime and it is said to provide a permanent improvement to acne.
  • WO02/13788 additionally discloses a "low dose, low energy” regime that is said to be designed to provide relief from acne.
  • 0.1 to 10 %wt ALA acid is applied, and after waiting for the ALA acid to penetrate the skin, is followed by irradiation with a light dose of 1 to 20 J/cm 2 .
  • WO02/13788 suggests that this regime be used in occasional multiple treatments to alleviate acne and be repeated as necessary to maintain diminishment thereof. Although it is recognised that use of such a regime may be pain free, the implication in WO02/13788 is that the therapeutic effect of this treatment regime is less than the high dose, high energy regime it describes and exemplifies.
  • substantially pain free e.g. pain free
  • therapeutically acceptable PDT
  • PDT can be achieved by modifying the photosensitiser-composition used in the PDT and/or altering the PDT procedure.
  • the invention provides the use of a photosensitiser which is 5-aminolevulinic acid (5-ALA) or a derivative (e.g. an ester) of 5-ALA, or a pharmaceutically acceptable salt thereof, in the manufacture of a composition for use in photodynamic therapy (PDT) on an animal, wherein said PDT comprises:
  • the invention provides a method of preventing or reducing side-effects (e.g. pain and/or erythema) of photodynamic therapy (PDT) in an animal, wherein said PDT comprises:
  • side-effects of PDT are prevented or reduced by use of (iii) or (iv) in combination with one or both of (i) and (ii).
  • the PDT has substantially the same therapeutic effect as the corresponding standard PDT treatment.
  • animal is meant herein any human or non-human being.
  • Preferred animals for treatment in accordance with the invention are humans.
  • 5-ALA and derivatives of 5-ALA are well known in the scientific and patent literature (see, for example, J.C. Kennedy et al., J. Clin. Laser Med. Surg.
  • the 5-ALA derivatives useful in accordance with the invention may be any derivative of 5-ALA capable of forming protoporphyrin IX (PpIX) or any other photosensitiser (e.g. a PpIX derivative) in vivo.
  • PpIX protoporphyrin IX
  • a PpIX derivative any other photosensitiser
  • such derivatives will be a precursor of PpIX or of a PpIX derivative (e.g. a PpIX ester) in the biosynthetic pathway for haem and which are therefore capable of inducing an accumulation of PpIX at the site to be treated following administration in vivo.
  • Suitable precursors of PpIX or PpIX derivatives include 5-ALA prodrugs which might be able to form 5-ALA in vivo as an intermediate in the biosynthesis of PpIX or which may be converted (e.g. enzymatically) to porphyrins without forming 5-ALA as an intermediate.
  • 5-ALA esters are among the preferred compounds for use in the methods herein described.
  • esters of 5-aminolevulinic acid and N-substituted derivatives thereof are preferred photosensitisers for use in the invention.
  • Those compounds in which the 5-amino group is unsubstituted i.e. the ALA esters
  • Such compounds are generally known and described in the literature (see, for example, WO96/28412 , WO02/10120 and WO2005/092838 to PhotoCure ASA, the contents of which are incorporated herein by reference).
  • Esters of 5-aminolevulinic acid with substituted or unsubstituted alkanols, i.e. alkyl esters are especially preferred photosensitisers for use in the invention.
  • alkyl esters include those of general formula I: R 2 2 N-CH 2 COCH 2 -CH 2 CO-OR 1 (I) (wherein R 1 represents a substituted or unsubstituted straight-chained, branched or cyclic alkyl group (e.g. a substituted or unsubstituted straight-chained alkyl group); and each R 2 independently represents a hydrogen atom or an optionally substituted alkyl group, e.g. a group R 1 ) and pharmaceutically acceptable salts thereof.
  • alkyl includes any long or short chain, cyclic, straight-chained or branched aliphatic saturated or unsaturated hydrocarbon group.
  • the unsaturated alkyl groups may be mono- or polyunsaturated and include both alkenyl and alkynyl groups. Unless stated otherwise, such groups may contain up to 40 atoms. However, alkyl groups containing up to 30, preferably up to 10, particularly preferably up to 8, especially preferably up to 6, e.g. up to 4 carbon atoms are preferred.
  • the substituted alkyl R 1 and R 2 groups may be mono or poly-substituted. Suitable substituents may be selected from hydroxy, alkoxy, acyloxy, alkoxycarbonyloxy, amino, aryl, nitro, oxo, fluoro, -SR 3 , -NR 3 2 and -PR 3 2 groups, and each alkyl group may be optionally interrupted by one or more -O-, -NR 3 -, -S- or -PR 3 - groups, in which R 3 is a hydrogen atom or a C 1-6 alkyl group).
  • Preferred substituted alkyl R 1 groups include those carrying one or more oxo groups, preferably straight-chained C 4 - 12 alkyl (e.g. C 8-10 alkyl) groups substituted by one, two or three (preferably two or three) oxo groups. Examples of such groups include 3,6-dioxa-1-octyl and 3,6,9-trioxa-1-decyl groups.
  • Particularly preferred for use in the invention are those compounds of formula I in which at least one R 2 represents a hydrogen atom.
  • each R 2 represents a hydrogen atom.
  • R 1 represents an unsubstituted alkyl group (preferably C 1-8 alkyl, e.g. C 1-6 alkyl) or an alkyl group (e.g. C 1-2 alkyl, especially C 1 alkyl) substituted by a substituent as hereinbefore defined (e.g. by an aryl group such as phenyl or by an alkoxy group such as methoxy) are also preferred.
  • R 1 represents an unsubstituted alkyl group (preferably C 1-8 alkyl, e.g. C 1-6 alkyl) or an alkyl group (e.g. C 1-2 alkyl, especially C 1 alkyl) substituted by a substituent as hereinbefore defined (e.g. by an aryl group such as phenyl or by an alkoxy group such as methoxy) are also preferred.
  • Unsubstituted alkyl groups which may be used in the invention include both branched and straight-chained hydrocarbon groups.
  • Compounds of formula I in which R 1 is a C 4-8 , preferably a C 5-8 , straight chain alkyl group which is branched by one or more C 1-6 (e.g. C 1-2 alkyl) groups are preferred.
  • Representative examples of suitable unsubstituted branched alkyl groups include 2-methylpentyl, 4-methylpentyl, 1-ethylbutyl and 3,3-dimethyl-1-butyl. 4-methylpentyl is particularly preferred.
  • R 1 is a C 1-10 straight-chained alkyl group
  • suitable unsubstituted alkyl groups include methyl, ethyl, propyl, butyl, pentyl, hexyl and octyl (e.g. n-propyl, n-butyl, n-pentyl, n-hexyl and n-octyl).
  • Hexyl, especially n-hexyl is a particularly preferred group.
  • Methyl is also particularly preferred.
  • R 1 represents a C 1-2 alkyl group (preferably a C 1 alkyl group) optionally substituted by an aryl group.
  • R 1 represents an alkyl group (e.g. C 1-2 alkyl, especially C 1 alkyl) substituted by an aryl group (e.g. phenyl).
  • Preferred substituted alkyl R 1 groups which may be present in compounds of formula I include C 1-6 alkyl, preferably C 1-4 alkyl, particularly preferably C 1 or C 2 alkyl (e.g. C 1 alkyl) substituted (preferably terminally substituted) by an optionally substituted aryl group.
  • aryl group is meant a group which is aromatic.
  • Preferred aryl groups comprise up to 20 carbon atoms, more preferably up to 12 carbon atoms, for example, 10 or 6 carbon atoms.
  • Aryl groups which may be present in the compounds of the invention may be heteroaromatic (e.g. 5-7 membered heteroaromatics) but are preferably non-heteroaromatic.
  • non-heteroaromatic is meant an aryl group having an aromatic system comprising electrons originating solely from carbon atoms.
  • Preferred aryl groups include phenyl and napthyl, especially phenyl.
  • one or two aryl groups may be present, preferably one.
  • Aryl groups which may be present in the compounds of the invention may optionally be substituted by one or more (e.g. 1 to 5), more preferably one or two, groups (e.g. one group).
  • the aryl group is substituted at the meta or para position, most preferably the para position.
  • Suitable substituent groups may include haloalkyl (e.g. trifluoromethyl), alkoxy (i.e. -OR groups wherein R is preferably a C 1-6 alkyl group), halo (e.g. iodo, bromo, more especially chloro and fluoro), nitro and C 1-6 alkyl (preferably C 1-4 alkyl).
  • Preferred C 1-6 alkyl groups include methyl, isopropyl and t-butyl, particularly methyl.
  • Particularly preferred substituent groups include chloro and nitro. Still more preferably the aryl group is unsubstituted.
  • a photosensitiser which is a compound of formula I wherein R 1 represents an aryl substituted C 1-4 alkyl group (preferably C 1-2 , e.g. C 1 ), preferably wherein said aryl group comprises up to 20 carbon atoms (e.g. up to 12 carbon atoms, especially 6 carbon atoms) and is itself optionally substituted, and each R 2 is as hereinbefore defined (e.g. each R 2 is hydrogen), or a pharmaceutically acceptable salt thereof in the manufacture of a medicament for use in PDT.
  • R 1 represents an aryl substituted C 1-4 alkyl group (preferably C 1-2 , e.g. C 1 ), preferably wherein said aryl group comprises up to 20 carbon atoms (e.g. up to 12 carbon atoms, especially 6 carbon atoms) and is itself optionally substituted, and each R 2 is as hereinbefore defined (e.g. each R 2 is hydrogen), or a pharmaceutically acceptable salt thereof in the manufacture of a medicament for use in
  • Preferred compounds for use in the invention include methyl ALA ester, ethyl ALA ester, propyl ALA ester, butyl ALA ester, pentyl ALA ester, hexyl ALA ester, octyl ALA ester, 2-methoxyethyl ALA ester, 2-methylpentyl ALA ester, 4-methylpentyl ALA ester, 1-ethylbutyl ALA ester, 3,3-dimethyl-1-butyl ALA ester, benzyl ALA ester, 4-isopropylbenzyl ALA ester, 4-methylbenzyl ALA ester, 2-methylbenzyl ALA ester, 3-methylbenzyl ALA ester, 4-[t-butyl]benzyl ALA ester, 4-[trifluoromethyl]benzyl ALA ester, 4-methoxybenzyl ALA ester, 3,4-[di-chloro]benzyl ALA ester, 4-ch
  • Still further preferred compounds for use in the invention include methyl ALA ester, ethyl ALA ester, 2-methoxyethyl ALA ester, benzyl ALA ester, 4-isopropylbenzyl ALA ester, 4-methylbenzyl ALA ester, 2-methylbenzyl ALA ester, 3-methylbenzyl ALA ester, 4-[t-butyl]benzyl ALA ester, 4-[trifluoromethyl]benzyl ALA ester, 4-methoxybenzyl ALA ester, 3,4-[di-chloro]benzyl ALA ester, 4-chlorobenzyl ALA ester, 4-fluorobenzyl ALA ester, 2-fluorobenzyl ALA ester, 3-fluorobenzyl ALA ester, 2,3,4,5,6-pentafluorobenzyl ALA ester, 3-nitrobenzyl ALA ester, 4-nitrobenzyl ALA ester, 2-phenylethyl ALA este
  • Particularly preferred compounds for use in the invention include methyl ALA ester, hexyl ALA ester and benzyl ALA ester, especially methyl ALA ester.
  • the compounds for use in the invention may be prepared by any conventional procedure available in the art (e.g. as described in WO02/10120 to PhotoCure ASA).
  • esters of 5-ALA may be prepared by reaction of 5-ALA with the appropriate alcohol in the presence of acid.
  • compounds for use in the invention may be available commercially (e.g. from Photocure ASA, Norway).
  • the compounds for use according to the invention may be in the form of a free amine (e.g. -NH 2 , -NHR 2 or -NR 2 R 2 ) or preferably in the form of a physiologically acceptable salt.
  • Such salts preferably are acid addition salts with physiologically acceptable organic or inorganic acids. Suitable acids include, for example, hydrochloric, nitric, hydrobromic, phosphoric, sulphuric, sulphonic and sulphonic acid derivatives. Hydroiodic acids may also be suitable.
  • Particularly preferred salts are acid addition salts with hydrochloric acid and sulphonic acid derivatives (e.g. mesylate or tosylate) as described in WO2005/092838 to PhotoCure ASA, the entire contents of which are incorporated herein by reference. Procedures for salt formation are conventional in the art.
  • a single photosensitiser as hereinbefore defined i.e. 5-ALA or a derivative of 5-ALA
  • a combination of two or more, preferably two, photosensitisers may be used wherein at least one of the photosensitisers is selected from 5-ALA and derivatives of 5-ALA, or a pharmaceutically acceptable salt thereof.
  • photosensitisers which may be formulated with 5-ALA or a derivative of 5-ALA (e.g. a 5-ALA ester) or co-administered in accordance with the invention include:
  • the second photosensitiser will be a Hematoporphyrin (e.g. Photofrin®), a chlorin (particularly m-THPC or chlorin e6) or a sulphonated phthalocyanine (particularly aluminium phthalocyanine di-sulfonate or aluminium phthalocyanine tetra-sulfonate).
  • a Hematoporphyrin e.g. Photofrin®
  • a chlorin particularly m-THPC or chlorin e6
  • a sulphonated phthalocyanine particularly aluminium phthalocyanine di-sulfonate or aluminium phthalocyanine tetra-sulfonate.
  • the PDT conditions still preferably ensure that few, if any, side effects of treatment occur. This may be achieved by use of at least one of (i)-(iv) as hereinbefore described and optionally a low dose (e.g. sub-therapeutic dose) of the second photosensitiser.
  • the invention provides the use of a first photosensitiser which is 5-ALA or a derivative of 5-ALA as hereinbefore defined, or a pharmaceutically acceptable salt thereof, together with a second photosensitiser in the manufacture of a composition for use in PDT as hereinbefore defined.
  • the compounds for use according to the invention may be formulated and/or administered with other active components which are able to increase the photosensitizing effect and thus enhance the PDT.
  • chelating agents may beneficially be included and/or co-administered in order to enhance the accumulation of Pp; the chelation of iron by the chelating agent prevents its incorporation into Pp to form haem by the action of the enzyme ferrochelatase, thereby leading to a build-up of Pp. The photosensitizing effect is thus enhanced.
  • Suitable chelating agents include aminopolycarboxylic acids, including any of the chelants described in the literature for metal detoxification or for the chelation of paramagnetic metal ions in magnetic resonance imaging contrast agents. Particular mention may be made of EDTA, CDTA (cyclohexane diamine tetraacetic acid), DTPA and DOTA and well known derivatives/analogues thereof. EDTA and DTPA are particularly preferred. To achieve the iron-chelating effect, desferrioxamine and other siderophores may also be used, e.g. in conjunction with aminopolycarboxylic acid chelating agents such as EDTA.
  • the chelating agent may conveniently be used at a concentration of 0.05 to 20%, e.g. 0.1 to 10% (w/w).
  • Penetration enhancers may also have a beneficial effect in enhancing the photosensitizing effect of the compounds for use in the invention.
  • Surface-penetration assisting agents especially dialkylsuphoxides such as dimethylsulphoxide (DMSO), may therefore also be included in the compositions for use in the invention and/or co-administered.
  • the surface-penetration assisting agent may be any of the skin-penetration assisting agents described in the pharmaceutical literature e.g. chelators (e.g. EDTA), surfactants (e.g. sodium dodecyl sulphate), non-surfactants, bile salts (e.g. sodium deoxycholate) and fatty acids (e.g. oleic acid).
  • Examples of appropriate surface penetrating assisting agents include isopropanol, HPE-101 (available from Hisamitsu), DMSO and other dialkylsulphoxides, in particular n-decylmethyl-sulphoxide (NDMS), dimethylsulphacetamide, dimethylformamide (DMFA), dimethylacetamide, glycols, various pyrrolidone derivatives ( Woodford et al., J. Toxicol. Cut. & Ocular Toxicology, 1986, 5: 167-177 ), and Azone ® ( Stoughton et al., Drug Dpv. Ind. Pharm. 1983, 9: 725-744 ), or mixtures thereof.
  • NDMS n-decylmethyl-sulphoxide
  • DMFA dimethylsulphacetamide
  • glycols glycols
  • various pyrrolidone derivatives Woodford et al., J. Toxicol. Cut. & Ocular Toxicology, 1986, 5
  • the surface penetration agent may conveniently be provided in a concentration range of 0.2 to 50% (w/w), e.g. about 10% (w/w).
  • compositions for use in accordance with the invention may additionally include lubricating agents, wetting agents, emulsifying agents, suspending agents, preserving agents, sweetening agents, flavouring agents, adsorption enhancers, e.g. surface penetrating agents as mentioned below, and the like.
  • the compounds for use according to the invention may be formulated in any conventional manner with one or more physiologically acceptable carriers or excipients, according to techniques well known in the art. Where appropriate, compounds or compositions for use in the invention are sterilized, e.g. by ⁇ -irradiation, autoclaving or heat sterilization, before or after the addition of a carrier or excipient where that is present, to provide sterile formulations.
  • the compositions of the invention may also be formulated so as to provide quick, sustained or delayed release of the active ingredient after administration to the patient by employing procedures well known in the art. Solubilizing and/or stabilizing agents may, for example, be used, e.g.
  • compositions may be in any appropriate dosage form, for example as an emulsion or in liposomes, niosomes, microspheres, nanoparticles or the like.
  • the compounds for use in the invention may then be absorbed to, incorporated in or bound to these forms.
  • the pH in the final composition is preferably in the range 2.5 to 7.4. Slightly acidic pH, for example pH 5-7, is preferred.
  • compositions may be administered systemically (e.g. orally or parenterally) or more preferably locally (e.g. by injection or topically) at or near the affected site.
  • the route of administration will depend on the severity, nature and location of the disease to be treated as well as the photosensitiser (or combination of photosensitisers) used. Generally, however, local administration, still more preferably, topical application is preferred. Topical administration to inaccessible sites may be achieved by techniques known in the art, e.g. by the use of catheters or other appropriate drug delivery systems.
  • compositions that may be administered systemically include plain or coated tablets, capsules, suspensions and solutions containing the active component optionally together with one or more inert conventional carriers and/or diluents, e.g. with corn starch, lactose, sucrose, microcrystalline cellulose, magnesium stearate, polyvinylpyrrolidone, citric acid, tartaric acid, water, water/ethanol, water/glycerol, water/sorbitol, water/ polyethyleneglycol, propyleneglycol, stearylalcohol, carboxymethylcellulose or fatty substances such as hard fat or suitable mixtures thereof.
  • inert conventional carriers and/or diluents e.g. with corn starch, lactose, sucrose, microcrystalline cellulose, magnesium stearate, polyvinylpyrrolidone, citric acid, tartaric acid, water, water/ethanol, water/glycerol, water/sorbitol, water/ polyethyleneglycol, propylenegly
  • compositions that may be administered locally (e.g. topically) include gels, creams, ointments, sprays, lotions, salves, sticks, soaps, powders, pessaries, aerosols, drops, solutions and any of the other conventional pharmaceutical forms in the art. Creams, ointments and gels are especially preferred.
  • Creams, ointments and gels may be formulated with an aqueous or oily base with the addition of suitable thickening and/or gelling agents.
  • Lotions may be formulated with an aqueous or oily base and will, in general, also contain one or more emulsifying, dispersing, suspending, thickening or colouring agents.
  • Powders may be formed with the aid of any suitable powder base.
  • Drops and solutions may be formulated with an aqueous or non-aqueous base also comprising one or more dispersing, solubilising or suspending agents. Aerosol sprays are conveniently delivered from pressurised packs, with the use of a suitable propellant.
  • compositions for use in PDT according to the invention will be in the form of a ready-to-use composition such as a cream or as a kit as hereinbefore defined.
  • concentration of the 5-ALA compounds described herein in the final compositions for PDT will vary depending on several factors including the chemical nature of the compound, the chemical composition, mode of administration and nature of the disease to be treated. Preferably, however, concentration ranges of less than 20 %wt, more preferably less than 10 %wt, still more preferably 0.05 to 8 %wt, yet more preferably 0.5 to 6 %wt, e.g. 1.5 to 4.5 %wt or 2 to 4 %wt are used. The most preferred concentrations for local (e.g. topical) administration is in the range 2 to 4 %wt.
  • the invention provides a pharmaceutical composition
  • a photosensitiser which is 5-ALA or a derivative of 5-ALA as hereinbefore defined and a pharmaceutically acceptable carrier or excipient, wherein the concentration of said photosensitiser is 2 to 8 %wt (e.g. 2 to 4.5 %wt).
  • the invention provides a pharmaceutical composition
  • a photosensitiser which is 5-ALA or a derivative of 5-ALA as hereinbefore defined and a pharmaceutically acceptable carrier or excipient, wherein the concentration of said photosensitiser is 2 to 8 %wt (e.g. 2 to 4.5 %wt) for use in therapy (e.g. PDT).
  • the invention provides a product or kit for use in a method of preventing or reducing side-effects (e.g. pain and/or erythema) of photodynamic therapy (PDT) in an animal comprising:
  • the composition contained in the first container comprises the composition which itself forms an aspect of the invention (i.e. a composition comprising a photosensitiser which is 5-ALA or a derivative of 5-ALA as hereinbefore defined in a concentration of 2 to 8 %wt (e.g. 2 to 4.5 wt%)).
  • a composition comprising a photosensitiser which is 5-ALA or a derivative of 5-ALA as hereinbefore defined in a concentration of 2 to 8 %wt (e.g. 2 to 4.5 wt%).
  • Further preferred products and kits comprise a second container containing a second photosensitiser, e.g. as hereinbefore defined.
  • the instructions present in the products and kits of the invention describe the steps of administering the composition comprising a photosensitiser to an animal and photoactivating the photosensitiser.
  • the instructions also preferably describe at least one of steps (ii), (iii) or (iv) as herein defined.
  • PDT is carried out by administering to an animal a composition comprising a photosensitiser as hereinbefore defined and photoactivating the photosensitiser.
  • a composition comprising a photosensitiser as hereinbefore defined and photoactivating the photosensitiser.
  • side effects is meant herein effects, usually undesirable effects, caused by PDT, other than its desired therapeutic effect.
  • Representative examples of side effects commonly associated with PDT include pain, erythema, swelling, edema, burning, itching, exfoliation, hyperpigmentation and prolonged irritation and hypersensitivity after treatment.
  • the uses and methods of the present invention are particularly useful for preventing or reducing pain and/or erythema, especially pain.
  • the PDT has substantially the same therapeutic effect as the corresponding standard PDT treatment, whilst preventing or reducing the side effects of the standard treatment.
  • corresponding standard PDT treatment is meant the PDT treatment carried out with the same photosensitiser (e.g. the same 5-ALA ester) and the same light dose (e.g. 37 J/cm 2 ), but under the following conditions:
  • Particularly preferred uses and methods of the invention provide at least 90 %, still more preferably at least 95 %, e.g. at least 99 % of the therapeutic effect of the corresponding standard PDT treatment.
  • compositions comprising the photosensitiser in a concentration of less than 10 % wt (e.g. 0.5 to 8 %wt).
  • compositions comprise photosensitiser in a concentration of 0.05 to 8 %wt, still more preferably 0.5 to 6 %wt, e.g. 1 to 4.5 %wt or 2 to 4 %wt.
  • the composition comprising the photosensitiser(s) as hereinbefore described is administered to the animal and a certain time period is allowed to elapse before the site to be treated is exposed to light to achieve the desired photosensitizing effect.
  • administered is meant that the composition is delivered to the animal. This may be achieved, for example, by applying the composition to the skin and allowing it to permeate therethrough.
  • the composition is administered in a single application. Before light exposure, excess photosensitiser is preferably removed.
  • the length of time following administration at which light exposure takes place will depend on the nature of the composition, the condition to be treated and the form of administration. It may be, for example, about 3 to 6 hours. In preferred uses and methods of the invention, however, side effects of PDT are prevented or reduced by use of (ii) as hereinbefore defined, i.e. by administering the composition for less than 2 hours prior to photoactivation. Still more preferably the composition is administered for 0 to 90 minutes (e.g. 5 to 90 minutes, preferably 30 to 90 minutes), more preferably 10 to 50 minutes, still more preferably 15 to 45 minutes, e.g. 20 to 40 minutes prior to photoactivation.
  • 0 to 90 minutes e.g. 5 to 90 minutes, preferably 30 to 90 minutes
  • 10 to 50 minutes still more preferably 15 to 45 minutes, e.g. 20 to 40 minutes prior to photoactivation.
  • light exposure may be effected immediately after administration of the photosensitiser, i.e. the period of administration may be a matter of only minutes (e.g. up to 10 minutes, more preferably up to 5 minutes) or may effectively be zero in the case where administration and photoactivation occur simultaneously.
  • photoactivation may be achieved using light sources known in the art.
  • Methods for the irradiation of different areas of the body, e.g. by lamps or lasers are well known in the art (see for example Van den Bergh, Chemistry in England, May 1986 p. 430-439 ).
  • the wavelength of light used for irradiation may be selected to achieve a more efficacious photosensitizing effect.
  • the most effective light is light in the wavelength range 300-800 nm, typically 400-700 nm.
  • the irradiation will in general be applied at a dose level of 40 to 200 Joules/cm 2 , for example at 100 Joules/cm 2 .
  • a light source having a fluence rate of 60 to 100 mW/cm 2 may be used.
  • side effects of PDT are prevented or reduced by use of (iii) as hereinbefore described, i.e. by photoactivating with a light source having a fluence rate of less than 50 mW/cm 2 .
  • photoactivation is carried out with a light source having a fluence rate of 5 to 40 mW/cm 2 , still more preferably 10 to 35 mW/cm 2 , e.g. 15 to 35 mW/cm 2 .
  • the irradiation is applied at a dose of 10 to 100 J/cm 2 , more preferably 20 to 60 J/cm 2 , e.g. about 37 Joules/cm 2 .
  • Penetration of light into tissues depends on the wavelength used and is deeper for red light than for blue light.
  • Irradiation is preferably performed for 5 to 30 minutes, preferably for 15 minutes, depending on the light dose and fluence rate.
  • a single irradiation may be used or alternatively a light split dose in which the light dose is delivered in a number of fractions, e.g. a 1 to 10 minutes between irradiations, may be used.
  • side effects of PDT are prevented or reduced by use of (iv) as hereinbefore defined, i.e. by photoactivating with sunlight.
  • This aspect of the invention includes photoactivation with either natural sunlight or any light source which provides artificial sunlight (i.e. the entire range from UV to IR).
  • natural sunlight as the light source has the advantage that the animal being treated is free to leave the clinical environment where treatment is normally conducted.
  • the intensity of sunlight (whether natural or artificial) is so low, exposure can commence as soon as administration begins (i.e. the administration time may effectively be zero).
  • photoactivation by sunlight may be effected immediately following administration of the photosensitiser.
  • the desired period of exposure to sunlight following administration of the photosensitiser will depend on various factors such as the nature of the composition, the condition to be treated, the form of administration, etc. but may readily be determined by those skilled in the art. It has, however, been found that the pain associated with PDT is less during the first 3 hours or so of exposure to sunlight and that this is sufficient for the desired therapeutic effects to be achieved. In a preferred aspect of the invention the period of exposure to sunlight may therefore be in the range of from 2 to 4 hours, e.g. about 3 hours.
  • side effects of PDT are prevented or reduced by use of (i) as hereinbefore defined in combination with at least one of (ii), (iii) and (iv).
  • side effects of PDT are prevented or reduced by use of (ii) as hereinbefore defined in combination with at least one of (iii) and (iv).
  • Prevention or reduction of side effects by use of (ii) in combination with (iv) is particularly preferred.
  • the photosensitiser is preferably administered for 15 to 45 minutes (e.g. for 30 minutes) prior to photoactivation. Preferably excess photosensitiser is not removed prior to photoactivation so administration may continue during the activation.
  • side effects of PDT are prevented or reduced by use of at least (i), (ii) and (iii) or (i), (ii) and (iv), e.g. (i), (ii) and (iii).
  • side-effects of PDT are prevented or reduced by use of (iii) in combination with (i) and/or (ii), e.g. by use of (iii) and (i); (iii) and (ii); or (iii) and (i) and (ii).
  • side-effects of PDT are prevented or reduced by use of (iv) in combination with (i) and/or (ii), e.g. by use of (iv) and (i); (iv) and (ii); or (iv) and (i) and (ii).
  • multiple treatments may be given, e.g. daily, weekly or monthly treatment.
  • no more than two treatments are required, e.g. for PDT of acne.
  • the methods and uses of the invention may be used to treat any disease known to be treatable by PDT.
  • diseases which may be treated include any malignant, pre-malignant and non-malignant abnormalities or disorders responsive to photochemotherapy e.g. cancers (e.g. basal cell carcinoma (bcc), tumours, squamous cell carcinoma (scc), Bowen's disease), skin disorders (e.g. psoriasis, actinic keratoses and acne) and infections (e.g. bacterial, viral or fungal infections, for example Herpes virus infections).
  • cancers e.g. basal cell carcinoma (bcc), tumours, squamous cell carcinoma (scc), Bowen's disease
  • skin disorders e.g. psoriasis, actinic keratoses and acne
  • infections e.g. bacterial, viral or fungal infections, for example Herpes virus infections.
  • the invention is particularly suited to the treatment of diseases, disorders or abnormalities
  • the uses and methods of the present invention are particularly suited to the treatment of diseases other than acne.
  • the internal and external body surfaces which may be treated according to the invention include the skin and all other epithelial and serosal surfaces, including for example mucosa, the linings of organs e.g. the respiratory, gastro-intestinal and genito-urinary tracts, and glands with ducts which empty onto such surfaces (e.g. liver, hair follicles with sebaceous glands, mammary glands, salivary glands and seminal vesicles).
  • such surfaces include for example the lining of the vagina, the endometrium and the urothelium.
  • Such surfaces may also include cavities formed in the body following excision of diseased or cancerous tissue e.g. brain cavities following the excision of tumours such as gliomas.
  • Exemplary surfaces thus include: (1) skin and conjunctiva; (2) the lining of the mouth, pharynx, oesophagus, stomach, intestines and intestinal appendages, rectum, and anal canal; (3) the lining of the nasal passages, nasal sinuses, nasopharynx, trachea, bronchi, and bronchioles; (4) the lining of the ureters, urinary bladder, and urethra; (5) the lining of the vagina, uterine cervix, and uterus; (6) the parietal and visceral pleura; (7) the lining of the peritoneal and pelvic cavities, and the surface of the organs contained within those cavities; (8) the dura mater and meninges; (9) any tumors in solid tissues that can be made accessible to photoactivating light e.g. either directly, at time of surgery, or via an optical fibre inserted through a needle.
  • the uses and methods of the invention are particularly suited, however, to the PDT treatment of diseases of the face, scalp or neck, especially the face.
  • the uses and methods of the present invention are particularly suited to the treatment of acne.
  • the term "acne” includes both inflammatory and non-inflammatory diseases of the pilosebaceous unit. Primarily, however, the uses and methods herein described will be used for treating inflammatory types of acne where bacterial invasion of the pilosebaceous unit or follicles has occurred.
  • the compounds described herein are preferably used for the treatment or prevention (preferably for the treatment) of acne associated with Propionibacterium bacteria (e.g. P. acnes, P. granulosum and P. avidum), especially Propionibacterium acnes.
  • Acne is categorised into different forms depending, for example, on the nature, severity and/or location of the blackheads, whiteheads, papules, pustules and/or cysts.
  • Representative types of acne which may be treated according to the invention include acne vulgaris, acne rosacea, acne conglobate, acne papulosa and premenstrual acne, preferably acne vulgaris which is a chronic inflammatory disease of the pilosebaceous apparatus.
  • Acne may occur on the back, chest, upper arms and/or face; the compounds described herein may be used for treating any of these areas of the body, especially the face.
  • the uses and methods of the present invention are also particularly suited to the treatment of cancers.
  • Representative examples of cancers that may be treated include bcc, tumors, scc and Bowen's disease.
  • MAL methylaminolevulinate
  • Patients were randomized to receive either MAL cream on the face at a concentration of 160 mg/g (16 %wt), 80 mg/g (8 %wt)or 40 mg/g (4 %wt). Patients had skin biopsies taken on one half of the face (each patient had a total of two biopsies taken) and the other half of the face was exposed to red light (37 J/cm 2 using Photocure's Aktilite 128 LED light source) as indicated in the table below. * Cream applied at 0 hrs.
  • Acne lesion counts (inflammatory and non inflammatory lesions for the half face exposed to red light) was performed at 0 hours as well as at day 14 and day 84 visits by a blinded evaluator. A Global Acne Severity Assessment was also performed at day 0, day 14 and day 84.
  • Porphrin levels were highest in facial skin of acne patients treated with MAL at 160mg/g for 3 hours and 80 mg/g for 1.5 hours. These elevated levels went back to baseline levels after red light exposure.
  • MAL-PDT treatment groups Surprisingly there was no difference between MAL-PDT treatment groups in inflammatory or non-inflammatory lesions at either day 14 or day 84. However a reduction from the start of the study in inflammatory lesions (between 23% to 44% at Day 84) was noted for all groups on the MAL-PDT treated side. There was no difference between treatment groups in Global acne severity scores or sebum excretion rates at day 14 and day 84 thus showing that all treatment regimes were equally efficient.
  • the treatment effect was evaluated as reduction in number of inflammatory acne lesions from baseline to 12-week control. Pain during illumination was assessed using a numerical scale ranging from 0 to 10 in which 0 is no pain and 10 is worst imaginable pain.
  • the treatment effect was scored by lesion counting before treatment and 12 weeks after the PDT treatment:

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